When performing rescue breaths on an infant, you cover both the mouth and nose with your mouth to form an airtight seal, then deliver small, gentle puffs of air, just enough to make the chest visibly rise. This technique differs significantly from adult CPR, where you pinch the nose and breathe into the mouth alone. An infant’s airway is tiny, and the amount of force that works for an adult can cause serious problems in a baby.
How to Position the Infant’s Head
Before giving any breaths, you need the airway open. For an infant, this means tilting the head into a slightly extended position, sometimes called a “sniffing position,” where the chin lifts gently and the nose points slightly upward, as if the baby were sniffing the air. This is far less of a tilt than you’d use for an adult or older child.
The reason is anatomical. Infants have a proportionally large head relative to their body, which naturally pushes the chin toward the chest when they’re lying flat. A slight extension straightens the airway. But tilting too far back actually makes things worse. Research using MRI imaging found that over-extending an infant’s head increases the chance the tongue or soft tissue slides backward and blocks the airway. The optimal angle for a patent airway falls in a narrow range corresponding to a mildly extended head, not a dramatic tilt. If you have a small rolled towel, placing it under the infant’s shoulders (not the neck) can help achieve this position naturally.
Creating the Seal and Delivering Breaths
Because an infant’s face is so small, you won’t be able to seal the mouth and pinch the nose separately the way you would with an adult. Instead, place your mouth over both the baby’s mouth and nose at the same time, creating one complete seal. If your mouth can’t cover both, the American Red Cross advises sealing over the nose and delivering breaths through it while keeping the mouth closed, though the mouth-and-nose method is standard for most rescuers.
The breath itself should be a small puff, not a full exhalation from your lungs. Think of the volume of air in your cheeks rather than your chest. An infant’s lungs are roughly the size of your fist, so they fill quickly. The key visual indicator: watch the chest. Each breath should produce a visible rise. If the chest doesn’t rise, something is wrong, and you need to adjust before trying again.
What to Do If the Chest Doesn’t Rise
If your first breath doesn’t produce chest rise, retilt the head and reposition your seal before giving the second breath. A poor seal or slightly off head position is the most common cause. If the second breath still fails to raise the chest, something may be physically blocking the airway. At that point, you should move into chest compressions, which can help dislodge an obstruction. Do not attempt a blind finger sweep of the infant’s mouth, as this can push an object deeper.
Rescue Breaths With a Pulse
If the infant has a pulse but is not breathing adequately, you give rescue breaths without chest compressions. The 2025 American Heart Association and American Academy of Pediatrics guidelines recommend 1 breath every 2 to 3 seconds, which works out to roughly 20 to 30 breaths per minute. Each breath should be just enough to see the chest rise, and you should let the air escape fully before delivering the next one.
Checking for a pulse in an infant is different from checking in an adult. The standard method is to feel for the brachial pulse on the inside of the upper arm, between the elbow and shoulder. Press gently with two fingers. That said, this can be difficult even for trained professionals. One study found that only about 47% of participants correctly located the brachial pulse, compared to 82% who could detect a heartbeat by placing an ear directly against the infant’s bare chest. If you’re struggling to find a pulse and the infant isn’t breathing, showing no signs of life, start CPR.
Rescue Breaths During Full CPR
When an infant has no pulse and needs full CPR, rescue breaths are paired with chest compressions. A single rescuer uses a ratio of 30 compressions to 2 breaths. After every 30 compressions, stop, give 2 gentle breaths watching for chest rise, then immediately resume compressions. If two people are available, the ratio shifts to 15 compressions to 2 breaths, which delivers more oxygen per minute.
Each of those 2 breaths should take about 1 second to deliver. Don’t rush them, but don’t linger either. The goal is to minimize the time you spend off the chest, since compressions are what keeps blood circulating to the brain and heart.
Avoiding Too Much Air
One of the biggest risks with infant rescue breathing is giving too much air or blowing too forcefully. Over-ventilation can push air into the stomach instead of the lungs, a problem called gastric inflation. A distended stomach presses against the diaphragm, making it even harder for the lungs to expand, and increases the risk of vomiting. In a newborn, applying gentle pressure to the front of the throat over the windpipe (cricoid pressure) has been shown to reduce stomach inflation, though this requires a second rescuer and is more of a clinical technique. For a single rescuer, the practical solution is simpler: use small puffs and stop the breath the moment you see the chest rise.
When to Call for Help
If you’re alone with an unresponsive infant and have a phone within reach, call 911 before starting CPR. If someone else is present, have them call immediately while you begin. The priority is getting emergency services dispatched as soon as possible, because infant emergencies can deteriorate quickly, and the interventions paramedics carry go well beyond what CPR alone provides.
If you don’t have immediate access to a phone, perform about 2 minutes of CPR first (roughly 5 cycles of 30 compressions and 2 breaths), then call. The reasoning is that most cardiac arrests in infants stem from breathing problems rather than heart problems, so those initial breaths and compressions address the most likely cause while you’re the only one there.